Provider Demographics
NPI:1770679862
Name:BRUNS, DENNIS DON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DON
Last Name:BRUNS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:W326 CENTRAL AVENUE
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334
Mailing Address - Country:US
Mailing Address - Phone:712-362-4449
Mailing Address - Fax:712-362-5313
Practice Address - Street 1:W326 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334
Practice Address - Country:US
Practice Address - Phone:712-362-4449
Practice Address - Fax:712-362-5313
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06534122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0002915Medicaid